In which Rob Campbell suggests the College of Medical Administrators get a new name

Thank you for the opportunity to meet with you this evening. I do miss the interactions I had with clinical, care and other people in the health system in the brief period I shared your workplaces.

There are many things I do not miss from the cloistered, controlled and distanced role I had then, but I do regret losing those personal interactions when I did manage to break free. Suffice to say that what I have to say tonight was not drafted by a “communications executive” nor vetted for propriety by a Minister’s office.

I come from the point of view that there is a “cluster crisis” in our health system comprised of many longstanding crises or comorbidities. Appreciation of that drove the Pae Ora reforms which are well-intentioned even with all their inherent faults.

As things now stand, despite best intentions, the health system retains all of those comorbidities and while treatments being applied have both good intentions and often sound diagnosis, we cannot have confidence of a full or timely outcome of pae ora/healthy futures.

While I was Chair of Te Whatu Ora, I was contacted frequently by staff expressing their concerns about senior and middle management competency. This flow has not changed a great deal since I was sacked.

Most request anonymity, many express fear of reprisals for raising issues, I first learned the term “institutional betrayal” in this context.

It is a big workforce, some disputes are inevitable, but it is impossible to avoid the conclusion that there are genuine issues around competency. Any organisation of scale relies on the competence and integrity of management at all levels. It also needs to show empathy for the issues facing staff and often this is absent.

I am not going to dwell on faults, mis-diagnoses or inadequate treatments this evening. Too much of that can increase despair, disaffection and distrust.

It can be exploited by those who do not share a genuine aspiration of an excellent, efficient, effective and equitable health system but who only seek political advantage or commercial opportunity.

Your College is, as I see it, committed to a much better overall health system than we have today and I will go further and suggest that there would be no contention amongst you that a soundly based, governed and managed public health agency forms a critical part of that.

So I take that premise, which I share, and suggest that a great deal more systematic attention has to be paid to leadership and management roles performed by clinicians across the system as a whole, if we are deliver pae ora/healthy futures.

Let’s focus tonight on what we can do about that.

1. Start with leadership.

In your objectives you talk about clinicians working in “leadership and management roles”. That is great. One of the big gaps within the health system is leadership. Too much management is not leadership but simply passive administration (you can even see that in your name which I suggest you revise). “Administration” is passive.

In a system crying out for change, leadership is much more important. The argument for clinician management is mainly about the capability to lead other clinicians and caregivers. Leadership is not about implementing the instructions of others. It is about openly facing challenges with those involved, not administering the current system.

2. Follow with involvement.

It is notable that genuine involvement of clinical managers in the reform process and in implementation has been partial, piecemeal, passive. You should not be putting up with this, but demanding active engagement across the system.

Change does not occur through “consultation” on prepared packages but on sharing power and information. You should be loudly demanding this, not waiting for invitations.

3. Break things.

There seems to be a fear of getting things wrong or making mistakes in the health reform process. How ironic that is when the current system is littered with mistaken or wrong situations, actions, and assumptions.

To effect change you have to take risks, experiment, accept failures as a price of progress. How bad do current services and stresses have to get before the opportunity costs of inaction are accepted as being too high.

Leaders take those risks, they do not avoid them or even seek permission. They are innovators. Administrators replicate the past, leaders create the future. Make your mind up which you wish to be.

4. Recognise that change occurs at the margin not at the median point of anything.

Averages are summations of past actions and neither predictions of future outcomes nor precursors of them. You will find the points of change at the margins.

So as leaders look for them there. There are many points of innovation in both the public and private sectors of our health system. Leadership should be seeking those out, supporting and driving them.

This will not come from the Ministry or politicians. Nor will it come from the agency bureaucracies whether in funding or operational roles. These are steeped in the past, in the average. Change must come from within. My your insights and motivation to change. To get real change requires people like you to be health entrepreneurs in approach.

Those are personal actions you can take. More focused on systemic matters here is what I suggest you should be urging on Minister, Ministry, Board and Executive Leadership:

1. Focus.

There are far too many objectives, priorities, plans etc to possibly be delivered with the resources available. Leaders have to define what will make a difference and that needs focus. The biggest, grandest, most exciting plan is probably a bad choice when time and resource are short.

There is too little clear focus in both the service delivery and change process right now. With your skills you will know this. You should be leading those in roles which have power but not insight to see how important this is.

2. Prioritise.

It follows that the point of disciplined focus is to prioritise. But not only that, to prioritise what will make a significant difference not just an announcement or media puff piece. It is more likely that those actively engaged will know what this is than a politician seeking election or a high level manager in a galaxy far away such as Wellington.

Make the genuine priorities from within the system clear and advocate for them.

3. Involve and trust.

Do not repeat past mistaken process and adopt or allow others to adopt a hierarchical view either on what is important or how to deliver it. To effect change you must have people involved, excited and motivated. That will not come from instructions but from engagement. This is where real communication occurs, not on the receiving end of email distribution lists.

These are all things which you should be representing in your own actions as managers if you are genuine agents of change and progress, and also what you should be advocating wherever the opportunity arises. I think a group, a College, such as yours can and should be an activist.
Otherwise as the old saying goes, if you are not part of the solution you are part of the problem.

But the biggest thing I think you should be urging is a willingness to accept mistakes and change in direction. Not everything in the Pae Ora Act or the Te Pae Tata (the Plan) is sound or equally important. Do not proceeded doggedly with those things which are not working.

If I can give one example: it seems obvious that primary sector reform has been undercooked. There is more complexity in the relationships between funding, existing provider structures, and other agencies impacting the determinants of health than the drafters and establishment planners anticipated.

That does not make the direction wrong but there is a need for more time and depth of analysis. This should not hold up urgent funding issues. Skilled leaders and managers would recognise this and alter process accordingly. I saw very little evidence that those in the Ministry or corporate leadership have a serious theory of change nor an understanding of the mechanisms to create radical change.

Your College should be actively promoting debate and action around these matters.

There are many other specific actions we could discuss. You will know far more than I when you apply that “focus, prioritise, involve” approach to your thinking. It will be challenging but few treatment plans for multiple comorbidities survive being put into action. They have to adjust and adapt to what the responses are. Same here.

So those are my messages. The hierarchy may not like all of this, but it will enable your members to make the contribution I suspect they would like to be making and I know they are not currently making. What’s the worst that can happen ? Only getting the sack and I can tell you that’s not so bad.